Author Topic: Codes for Substance Abuse...  (Read 650 times)

KathyG

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Codes for Substance Abuse...
« on: February 28, 2013, 01:17:55 PM »
Could anyone help me with the proper codes to use for drug and alcohol related services in an office setting?  DX is 305.00.  I need advice on the procedure code for the initial evaluation, individual sessions (>45 mins.), and for group sessions with peers.  I have not billed for substance abuse before and just used the usual behavioral health codes (now 90791, 90834, and 90853) for this current claim with the DX of 305.00 (Non-Dependent Alcohol Abuse).   Aetna is not recognizing services as coded as being related to substance abuse, which reduces the co-payment of $10 to $0 for the patient if the treatment is drug/alchohol related.  Thanks!


James B

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Re: Codes for Substance Abuse...
« Reply #1 on: February 28, 2013, 02:48:02 PM »
Not sure if this helps, but we have up to 100 suboxone patients at any time. I bill 90791 for initial visits with 304.00 as the diagnosis code. For office visits, we typically bill something like 99213 (depending on the exact nature/complexity of visit) with the same diagnosis code.

The 90853 group therapy code remains the same.

This is for treatment of opiate addiction with a prescription drug, though, so it is perhaps similar but different.

KathyG

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Re: Codes for Substance Abuse...
« Reply #2 on: March 01, 2013, 11:53:27 AM »
Thanks, James!

Sounds like we are treating this the same way, which is good to know.  I assume you are getting paid...so maybe it was just a "glitch" and the claims will be paid if I appeal.  I was told by Aetna that those CPT codes are not picking up the substance abuse services, but I would think that the DX would indicate substance abuse treatment.

Take care...

Kathy G. :)


jeannefmiller

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Re: Codes for Substance Abuse...
« Reply #3 on: March 15, 2013, 04:41:59 PM »
We have an Intensive Outpatient Program that we bill using two different codes - 90899 and H0015.  Some insurance companies pay with no problems; others we are still "fighting" with because they authorize H0015 and then will not pay.  As far as we can find, there is NO CODE for IOP.  If anyone has a different code please let me know.  Thanks.